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Anti-GERD Medications in Infants with Regurgitation

Am Fam Physician. 2008 Jul 15;78(2):262-264.

Background: Khoshoo and colleagues observed an increase in the rate of primary care referrals to their pediatric gastroenterology practice, specifically of infants with regurgitation. They also documented that increasing numbers of referred infants had been placed on anti-gastroesophageal reflux disease (GERD) medications. These findings prompted them to analyze how many of the referred infants actually had GERD.

The Study: This study was a retrospective chart review. The authors reviewed the records of referred infants, including only neurodevelopmentally normal, term infants who had no specific risk factors for GERD (e.g., exposure to secondhand smoke, respiratory tract illnesses). They used diagnostic tests, especially pH monitoring, to assess the actual incidence of GERD in the referred infants.

Results: Of the 92 identified infants, 64 met the inclusion criteria. Mean age of studied infants was 17.6 weeks. Methods used to improve symptoms of regurgitation before referral included thickening feeds, mostly with cereals (81.3 percent), using antireflux medications (90.6 percent), and changing the formula (85.9 percent). Of the 64 infants, 44 underwent pH monitoring. Of the 20 infants who did not undergo pH monitoring, four had pyloric stenosis, one had renal tubular acidosis, and 15 did not have symptoms sufficiently indicative of GERD and, therefore, did not undergo the test. Overall, 13 infants in the study had abnormal findings; only eight had GERD.

Anti-GERD medication was withdrawn from 51 infants, and the parents were counseled on appropriate thickening of formula. Of these infants, 45 were available for follow-up at one to four weeks; six had worsening of symptoms, and 39 had no change or improvement of symptoms.

Conclusion: Based on the observation that most infants referred for evaluation of GERD do not have the condition, the authors conclude that physicians are over-referring infants with reflux symptoms and are inappropriately treating them with anti-GERD medications. The infants in this study were often overfed, and their formula was under-thickened. Formula should be thickened with one tablespoon of dry rice cereal per ounce of formula and fed in small amounts to prevent regurgitation. Infants whose only symptom is regurgitation and who have weight gain of 15 g per day or more are unlikely to have serious pathology.